Last month, I had the opportunity to address The California Technology Assessment Forum, a core program of The Institute for Clinical and Economic Review (ICER). ICER is a non-profit organization that “evaluates evidence on the value of medical tests, treatments and delivery system innovations and moves that evidence into action to improve the health care system.”
In simple terms, ICER looks at drugs, medical treatments, and prevention programs and asks two fundamental questions:
- Has the treatment amassed enough clinical evidence that we know it works?
- Does the treatment create value in the healthcare system?
On June 24, ICER held a meeting to discuss Diabetes Prevention Programs. That meeting included an evaluation of evidence on three types of DPPs – in-person programs with group coaching, digital programs with human coaching (Omada’s category), and digital programs with automated coaching.
Today, ICER released the final report on their evaluation of Diabetes Prevention Programs. Guided in part by the evidence our company submitted on the topic, digital programs with human coaching were determined to offer a “net health benefit superior to that of usual care.” Digital programs with human coaching joined in-person DPP in achieving care value. Digital programs with automated coaching did not meet the evidence requirements to achieve this rating. ICER’s report adds to the conclusions of 11 other supportive organizations, including the American Diabetes Association, the American Hospital Association, and the United States Preventive Services Task Force: both in-person, and digital DPP programs with human coaching deliver value to the healthcare system.
In addition to rating three types of DPP programs, ICER’s report also:
- Encouraged payers to cover CDC-recognized DPPs in a variety of formats across all plans with no copay. It also stated that payers should establish pay-for-performance contracts with DPP providers based on participation, retention, and weight loss.
- Suggested clinicians screen eligible patients for prediabetes, and when identified, immediately refer patients to a local or digital DPP.
- Recognized that DPP Providers should apply for CDC recognition, and tailor programs for diverse populations like seniors and low-income individuals. The report encouraged DPP providers to collaborate with payers to develop pay-for-performance pricing.
ICER’s release this morning validates the approach we’ve taken as a company. It was especially rewarding for us to provide the evidentiary foundation for the committee’s finding on the effectiveness and value of digital programs with human coaching.
Below, I’ve included a copy of my remarks:
Good morning. I’m the CEO of Omada Health, one of the earliest – and now the biggest – digital plus human coaching DPP provider. It’s an honor to be here. First, I’d like to thank ICER and CTAF for conducting this thorough and thoughtful report. This is truly an incredible contribution to the space. It is work that needed to be done, and could not have come at a more critical moment.
Over the last five years, the foundations of the CDC’s National Diabetes Prevention Program have been laid. Guidelines are in alignment that these programs should be offered as first line for people at high risk for diabetes. Seniors across America have just heard that Medicare is designing a DPP benefit for them.
There is truly no doubt we’re at a tipping point when it comes to the prevention of one of the most pervasive chronic diseases in America.
The voting questions being considered by this panel have asked us to contrast DPP against “usual care.” I’d like to share a story about what usual care feels like, from a patient perspective.
Five years ago, while I was still enrolled in medical school, and before anyone in our company had written a single line of software code for Omada, my co-founder and I traveled to rural Georgia to sit in the living rooms of people who had been recently diagnosed with prediabetes. We wanted to find out what these people had been offered to help prevent progressing to the disease.
What we found was scary.
The people we talked to felt abandoned. After finding out they were at high risk of a deadly disease, they were – at best – handed a pamphlet, told to change their lifestyles, and lose weight. On their own, with no social support or ongoing guidance. That was it.
Imagine that for a moment. Imagine being told you were literally scheduled to progress to a disease that would affect nearly every aspect of your life. But imagine you didn’t have any idea where you could turn for that help and support. And imagine knowing that your physician felt equally powerless to get you into a program. Physicians handed over that pamphlet, but knew deep down that the odds of success for that patient were low.
That was five years ago. And despite some progress, this is still the standard of usual care for the overwhelming majority of Americans. At Omada, we are immensely proud that we’ve now enrolled more than 60,000 people into our program. But we know, and the whole diabetes prevention community knows, that our work has just begun. As noted in the draft report, commercial adoption lags behind both the guideless, and the obvious need.
On the whole, we found the evidence review in report to be thorough and thoughtful, and we agree with its ultimate conclusions. We did wonder why digital was found to have a higher budget impact in year 1 and 2, given similar clinical effectiveness. We worry this point has the potential to discourage commercial payers with higher churn and short payback periods from offering a full range of DPP options to their membership.
However, we concur that the evidence supports a B+ recommendation for both in-person, and digital plus human coaching. We now have more than seven and a half million weight readings across our 60,000+ enrollees that align to the peer-reviewed results we have submitted to this panel.
We also agree that the evidence shows both in-person DPP and digital plus human coaching to be cost-effective or cost-saving. This report, and this evidence-based rating, will not be the end of our clinical publishing. We consider the rating a foundation -- a standard we will continue to justify with evidence generation and publication of peer-reviewed results.
Two points in the report rang especially true, and brought me back to those living rooms in Georgia five years ago. It highlighted that in low-income communities, where the burden of diabetes is greatest, that not having a close DPP location, access to childcare, or transportation capabilities are immense barriers.
In California, the report noted that rates of prediabetes in are higher in the Central Valley, but there are few in-person DPPs available in the region. These factors are why access to both digital plus human coaching and in-person DPPs are mission critical.
I’d like to close with something I found fascinating in the report, which was actually in Appendix D. In that section, CTAF reviewed 11 clinical guidelines to evaluate their stance on DPP. The ADA, the AHA, the AACE, ACE, NICE, the USPSTF, and five other respected organizations unanimously support that patients at risk of diabetes should be referred into intensive lifestyle interventions as first line.
This is remarkable. There’s fabulous alignment by a diverse group medical societies that don’t always agree. Yet there remains a mile-wide gap between usual care and the implementation of these guideline recommendations.
It is for this reason that I think the magnitude of the benefit for both in person and digital plus human DPP is “high” relative to usual care.
Today is an important day. It is being watched by payers, providers, and patients. This is a moment that can serve as a tipping point for how we as a country give people at risk of diabetes the best possible support to delay or avoid the terrible disease.
This review of the evidence and the vote today are momentous, because they’re a chance to not only validate a clinical intervention, but validate approaches to scaling the intervention to meet the massive need.
This meeting is a chance to make a difference in the lives of millions of Americans.
Thank you for allowing me to share my perspective.